Part two - trauma Flashcards
Parklands formula
4ml/kg x BSA (2nd and 3rd degree) gives amount of IVF required in 24 hours
Give half in first 8 hours FROM INJURY
Wallace rule of nine
Head - 9% Torso front - 18% Torso back - 18% Arms - 9% each Legs - 18% each
Referral criterial to burns unit
- > 10% TBSA in adult or >5% in a child
- Full thickness burns> TBSA
- Special areas - face, hands, genitalia, perineum, major joints, circumferential limb or chest
- Burns with inhalation injury
- Electrical and chemical burns
- Burns with pre-existing illness
- Burns associated with major trauma
- Burns at extremes of age - young kids & elderly
- Burns in pregnancy
- Non-accidental burns
Superficial burns (1st degree)
- Epidermis and papillae involved only
- Erythema, serum-filled blisters
- Skin blanches
- Painful / sensate
- Heals within 10 days without scarring
Partial-thickness burns (2nd degree)
- Epidermis loss with varying degrees of dermis
- Pink and white
- May or may not blanche on pressure
- Variable degrees of reduced sensation
- Heals in 14 days
- Some depigmentation may occur
- May require grafting
Full thickness burns
- Epidermis and dermis destroyed
- White and no blanching
- Insensate
- Without grafting healing occurs from wound edge
Three zones in burn wounds
- Zone of coagulation
- Occurs at point of maximum damage
- Irreversible tissue loss due to coagulation of constituent proteins
- Zone of stasis
- Surrounds zone of coagulation
- Decreased tissue perfusion
- Tissue is potentially salvageable
- Burns resuscitation is to increase tissue perfusion here and prevent the damage becoming irreversible
- Additional insults - like hypotension, infection, oedema - can convert this area into complete tissue loss
- Zone of hyperaemia
- Outermost zone
- Perfusion increased
- Tissue will invariably recover unless severe sepsis or prolonged hypoperfusion
Define pneumothorax
Accumulation of air in the pleural space
Define damage control
Technique whereby the surgeon minimises operative time and intervention on the grossly unstable patient to minimise hypothermia, coagulopathy and acidosis.
Stages of damage control
Stage 1 - Patient selection, see indications above
Stage 2 - Control of haemorrhage and contamination with temporary abdominal closure
Stage 3 - Restoration of physiology in ICU - temperature, coagulopathy, oxygenation, avoidance ACS
Stage 4 - Definitive operative management once stage 3 achieved
Stage 4 - Abdominal wall closure which may include reconstruction
Aims of temporary abdominal closure
- prevent evisceration
- actively remove any infected or toxic fluid from the peritoneal cavity
- prevent the formation of enteroatmospheric fistulas
- preserve the fascia and the abdominal wall domain
- achieve early definitive closure.
Define Pringle’s manoeuvre
Compression of the hepatic pedicle via the foramen of Winslow
How long can Pringle’s manoeuvre be used for?
Up to an hour in trauma in HDS patient
Probably on 15 mins in shocked patient
15 mins on / 5 mins off in elective surgery
Predictors of the success of non-operative management for splenic trauma
Grade/severity - failure rates 5/10/20/40/80%
Multi-trauma
Anticoagulants
Active bleeding
